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Detroit, MI, United States

Neil E.,Childrens Hospital of Michigan
Italian journal of pediatrics | Year: 2010

Liver failure in neonates is a rare but often fatal disease. Trisomy 21 is not usually associated with significant infantile liver disease. If present, hepatic dysfunction in an infant with Trisomy 21 is likely to be attributed to transient myeloproliferative disorder with hepatic infiltration by hematopoietic elements and may be associated with secondary hemosiderosis. A less commonly recognized cause of liver failure in neonates with Trisomy 21 is neonatal hemochromatosis (NH); this association has been reported in nine cases of Trisomy 21 in literature. NH is a rare, severe liver disease of intra-uterine onset that is characterized by neonatal liver failure and hepatic and extrahepatic iron accumulation that spares the reticuloendothelial system. NH is the most frequently recognized cause of liver failure in neonates and the commonest indication for neonatal liver transplantation. Although porto-pulmonary hypertension (PPH) has been reported as a complication of liver failure in adults and older children, this has not been reported in neonates with liver failure of any etiology. This is probably due to the rarity of liver failure in newborns, delayed diagnosis and high mortality. The importance of recognizing PPH is that it is reversible with liver transplantation but at the same time increases the risk of post-operative mortality. Therefore, early diagnosis of PPH is critical so that early intervention can improve the chances of successful liver transplantation. We report for the first time the association of liver failure with porto-pulmonary hypertension secondary to NH in an infant with Trisomy 21. Source


Veire A.,Childrens Hospital of Michigan
The Journal of the Michigan Dental Association | Year: 2012

Management of dental trauma in children can be a challenging problem in dental practices. Knowledge of current trauma guidelines is vital in effectively managing dental trauma so that favorable outcomes are achieved. The purpose of this paper is to review the current guidelines and management strategies of dental trauma in primary and permanent dentitions. When planning emergency treatment for a primary tooth, it is important to consider the lifespan of the tooth, the potential damage to the permanent dentition, and the behavior of the child. After injury to permanent teeth, the treatment strategy is dictated by the concern for vitality of the periodontal ligament and pulp of the injured tooth. The emergency nature of dental trauma requires that the dentist be knowledgeable and readily available during and after office hours to provide care. Source


Slovis T.L.,Childrens Hospital of Michigan
Pediatric radiology | Year: 2011

In the last decade, there has been recognition of the effects of low-dose radiation in children. A critical mass of scientists, health care providers and manufacturers of radiation-producing imaging equipment has come together to educate ordering physicians to request only indicated examinations and radiologists to achieve low-dose examinations with diagnostic images. The forces that caused these changes will be discussed. Source


Slovis T.L.,Childrens Hospital of Michigan
Pediatric radiology | Year: 2011

Sedation and anesthesia for pediatric imaging departments has changed dramatically for the following reasons: (1) radiologists have stopped sedating patients; (2) the majority of sedations are not for CT (because of the speed of the procedure) but for MR, which lasts 45 min or greater; (3) a cadre of services--pediatricians, emergency medicine physicians, hospitalists and intensivists, as well as anesthesiologists--can provide the services. These changes have significantly influenced the type of agents utilized for sedation and anesthesia and, most important, have created operational issues for MR departments. Nevertheless, it is important for each imaging department to create a uniform approach to sedation, taking into account patient expectations, efficiency of through-put, facilities and personnel available, and institutional costs. Source


Plant A.L.,U.S. National Institute of Standards and Technology | Parker G.C.,Childrens Hospital of Michigan
Stem Cells and Development | Year: 2013

Stem cell therapies show great medical promise, but few new products have made it into the marketplace. The translation of stem and other cell therapies faces not only challenges associated with research and development, but also the challenges of investment funding and regulatory approval. Regulators and investors alike appear to be voicing the same concerns: they see (1) insufficient high-quality data to provide confidence regarding the claims of medical benefit, (2) an insufficient understanding of the mechanism of action, and (3) a lack of identification of essential characteristics for product release criteria and for assuring reproducibility in manufacturing. The ensuing frustration on the part of researchers and developers may be the result of failure to fully comprehend what is required to assure that confidence. © Copyright 2013, Mary Ann Liebert, Inc. 2013. Source

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